Fostering Harmonious Interactions in a Boy with Congenital Deaf-Blindness: A Single-Case Study

Article excerpt

From birth, children with deaf-blindness experience serious difficulties in daily conversations with their educators (Bruce, 2003; Hart, 2006, 2010; Miles & Riggio, 1999; Vervloed, Van Dijk, Knoors, & Van Dijk, 2006). Harmonious interactions form the foundation of healthy social-emotional and communicative development. The attunement of affect and reciprocity play a crucial role in early parent-infant conversations (Trevarthen & Aitken, 2001). Interpersonal communication, through which infants learn to express and share emotions and intentions, can develop only within a secure relationship characterized by mutual attention, behavioral and emotional reciprocity, and the dynamic attunement of affect (Siegel, 1999; Stem, 1985/2000; Trevarthen & Aitken, 2001).

In previous work, we described harmonious interactions as the smooth and balanced attunement of behaviors and emotions (Janssen, Riksen-Walraven, & Van Dijk, 2003b). For children with congenital deaf-blindness, educators bear the greatest responsibility for creating harmony in interactions with these students. Both educators and children urgently need good intervention programs to improve the quality of their everyday interactions (Janssen et al., 2003a; RCdbroe & Souriau, 1999; Vervloed et al., 2006). Several educator-oriented intervention studies have been conducted with children who are congenitally deaf-blind.

Chen and Haney (1995, 1999) designed an intervention aimed at enhancing the responsiveness of caregivers that was evaluated with 25 infants, their parents, and 16 interventionists. The result was that the caregivers showed an increased ability to detect and respond to the needs of the infants (Chen & Haney, 1999). Nafstad and Rodbroe (1999) developed the "co-creation communication model." Interventions involving 10 people with deaf-blindness (ranging in age from 8 to 28 years) had positive effects on the transformation of spontaneous mimetic, imitative bodily tactile gestures into significant symbols for all the individuals (Nafstad & Vonen, 2000). Elements of this model have been applied in other studies as well (Daelman, Nafstad, Rodbroe, Souriau, & Visser, 1999; Hart, 2006).

Bruce (2002, 2008) conducted an intervention study with two teachers and three of their students that focused on four aspects of communication: form, functions, content, and context. The intervention consisted of in-service training and follow-up support, after which the teachers were able to plan and implement interventions that addressed their students' needs across all four aspects of communication. The study confirmed the importance of follow-up support (for example, with stimulated recall sessions), which allowed the teachers to make explicit connections between their thinking and actions.

In earlier publications, we presented the Diagnostic Intervention Model (DIM) as a guide to the design and implementation of interventions to foster harmonious interactions with individuals with deaf-blindness in various settings (Janssen et al., 2003b). This intervention model was empirically grounded in three intervention studies (Janssen, et al., 2002, 2003a, 2004). Five of the six cases from the third intervention study were described in previous publications (Janssen et al., 2006; Janssen, Riksen-Walraven, Van Dijk, & Ruijssenaars, 2010; Janssen, Riksen-Walraven, Van Dijk, Ruijssenaars, & Vlaskamp, 2007). The aim of the study presented here was to demonstrate the effectiveness of DIM in everyday practice by describing a single-case study. We conclude by elaborating on the most important implications of the case for everyday practice.

Method

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The study followed the tenets of the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects, as approved by the Institutional Review Board of Royal Kentalis in Sint-Michielsgestel, the Netherlands. …